Circuitous diagnosis in concealed self-poisoning with Nerium oleander **
Abstract
Clinical Toxicology (2012), 50, 228â229 Copyright © 2012 Informa Healthcare USA, Inc. ISSN: 1556-3650 print / 1556-9519 online DOI: 10.3109/15563650.2011.653569 LETTER TO THE EDITOR Circuitous diagnosis in concealed self-poisoning with Nerium oleander* To the Editor: A 60-year-old male prisoner, with a known history of depression, collapsed while walking in the garden of the prison. At examination, the physician noted that he complained of gastrointestinal discomfort, nausea, abdominal pain and cold sweat. His blood pressure was 90/60 mmHg, heart rate 64 beats per minute and Glasgow Coma Scale score 11. There were no signs of seizure. The first diagnosis suspected by the physician was an acute myocardial infarction. An electrocardiography (ECG) was performed, which excluded this cause. Deliberate self-poisoning was not at first suspected because the patient had consistently refused antidepressant treatment and was not taking any other drug. He was followed by a psychiatrist once a month. The patient was transported under medical supervision to the emergency department. After admission, he continued to vomit without chest pain. Abdominal palpation showed epigastric tenderness without guarding or tenseness. His condition abruptly worsened with mental confusion, weakness and bradycardia with sino-atrial node block and junctional escape rhythm leading to isorhythmic dissociation